Fixation of the glans penis and urethral catheter to the abdominal skin to avoid wound dehiscence after a hypospadias surgery: A comparative study.

To evaluate the effect of glanular and urethral catheter fixation to the abdominal skin on wound dehiscence

A different perspective for morbidity related to Fournier's gangrene: which scoring system is more reliable to predict requirement of skin graft and flaps in survivors of Fournier's gangrene?

PurposeTo identify the prognostic factors that might predict morbidity related to Fournier's gangrene (FG) and particularly requirement of skin grafting and flaps. We also evaluated the validities of different severity indexes.MethodsThirty male patients with complete data who were treated for FG between January 2012 and December 2018 were retrospectively evaluated. Fournier's Gangrene Severity Index (FGSI), Uludag Fournier Gangrene Severity Index (UFGSI) and Age-Adjusted Charlson Comorbidity Index (ACCI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, the Combined Urology and Plastics Index (CUPI) and neutrophil-lymphocyte ratio (NLR) were calculated for 27 surviving patients. These patients were divided into two groups: Group I (14 patients with primary skin closure) and Group II (13 patients with requiring skin grafting and flaps).ResultsBody temperature (p=0.026), heart rate (p<0.001), respiratory rate (p=0.029), creatinine (p=0.002), white blood cell count (p=0.014), hemoglobin levels (p=0.018), involvement of pelvic floor or beyond (p=0.018), length of hospital stay (p=0.049), previous endourologic instrumentation (p=0.035), requirement of cystostomy (p=0.041), colostomy (p=0.046), orchiectomy (p=0.034) and intensive care unit (p=0.046) were found to be significantly higher in Group II. All six different scoring systems were significantly higher in the patients who underwent skin grafting and flaps. In multivariate analysis, heart rate, FGSI, UFGSI, NLR, requirement of colostomy and intensive care unit were determined as independent factors for predicting requirement of skin grafting and flaps.ConclusionFGSI, UFGSI and NLR are more reliable parameters for predicting skin reconstruction method (with the threshold values of 4.5, 5.5, and 7.87, respectively)

Obituaries: Turgay (Türkay) Ateş

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The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

ABSTRACT Objective: To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats. Materials and Methods: A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham oper- ated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS). Results: JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43%) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14%) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4. Conclusion: The present study indicated that spermatic cord administration of alprostadil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular ischemia reperfusion injury

Tubularized incised plate urethroplasty results in patients with proximal hypospadias

Amaç: Proksimal hipospadyaslı primer vakalarda uygulanan “tubularized incised plate” üretroplasti (TIPU) tekniğinin klinik sonuçlarının değerlendirilmesini amaçladık. Yöntemler: Kliniğimizde 2003–2011 tarihleri arasında, eksternal üretral meatusu proksimal penil veya penoskrotal seviyede olan ve TIPU tekniğiyle onarım yapılan 33 primer hipospadyaslı vaka geriye dönük olarak değerlendirildi. Ameliyat sonrası fistülsüz işeme başarı olarak değerlendirildi. Bulgular: Hastaların ortalama yaşı 6,82±3,07 (1–13) idi. Hastaların 15’inde (%45,4) penoskrotal, 18’inde (%54,6) proksimal penil seviyede izlenen üretral meatus bulunmaktaydı. Hastalar üretral kateter çekildikten hemen sonra, taburcu edildikten 2 hafta ve 6 ay sonra idrar yaparken gözlemlenerek değerlendirildiler. İlk operasyon sonrası penoskrotal seviyede 5/15, proksimal penil seviyede 10/18 oranlarında fistülsüz işeme sağlandı; ilk operasyonlar sonrası genel başarı %45,5‘ti. Fistüllü işeyen hastalara yapılan ikinci operasyon ile bu oranlar penoskrotal seviyede 9/15, proksimal penil seviyede ise 16/18’e yükselmiş; total başarı oranı ise %75,8 bulunmuştur. Sonuç: Günümüzde ileri derecede kordisi olmayan proksimal hipospadyas olgularında üretral plate gelişiminde önemli bir bozukluk yoksa TIPU tekniği, deneyimli merkezlerde güvenle tercih edilebilecek bir yöntemdir.Objective: To evaluate the results of the patients with primary proximal hypospadias repaired by “tubularized incised plate” urethroplasty (TIPU). Methods: Thirty-three patients who were operated with TIPU technique in our clinic between 2003-2011 for primary hypospadias with proximal penile and penoscrotal meatus were retrospectively evaluated. Evaluation of the success in this study was, “voiding without fistula”. Results: Mean age was 6.82±3.07 (1-13). Fifteen patients (45.4%) had penoscrotal and 18 patients (54.6%) had proximal penil meatus. Postoperative success was evaluated with direct vision of voiding at the time of uncatheterization, 2 weeks and 6 months after un-catheterization. Success rates were 5/15 and 10/18 after the first repair in the level penoscrotal and proximal penil, respectively. Overall success rate was 45.5% after the first repair. Patients with urethral fistula after first repair were undergone second repair, success rates were increased to 9/15 and 16/18 in the levels of penoscrotal and proximal penil, respectively. Overall success rate after second repair was 75.8%. Conclusion: TIPU may be confidently applied for the patients with proximal hypopadias in experienced clinics, if there is not an uretral cordi or/and abnormality in the development of urethral plate